AIM: To examine the relation between stenosis of the internal carotid artery (ICA) and pulsatile ocular blood flow (POBF). METHODS: In 57 eyes of 30 patients who were referred for Doppler ultrasound examination of the ICA we measured POBF and analysed the correlation with degree of ipsilateral ICA stenosis. RESULTS: There was a significant negative correlation between POBF and ipsilateral ICA stenosis (Pearson correlation coefficient, r=-0.516, p<0.0001). In 14 eyes POBF could not be measured by the OBF tonometer, and in 11 of these cases (79%) severe stenosis (>75%) of the ipsilateral ICA was present. When these eyes were excluded from analysis, there was no correlation between POBF and ICA stenosis (r=-0.02, p=0.91). Among these 43 eyes in which POBF could be measured it ranged 667-2095 microl/min with a mean of 970.72 microl/min. CONCLUSION: Low or unrecordable POBF may signify severe stenosis of the internal carotid artery. POBF is not a direct reflection of ipsilateral ICA blood flow.